acute hep c and sovaldi

May 23, 2014

hi doc, is it correct that the 12 week sovaldi+rib+peg treatment is not available to sufferers of acute hep c? apparently my infection is so new, levels have not evened out yet, that I have to wait 4 more weeks to get tested again before I can start treatment. but I'm told that sovaldi is not an option so I have to accept the 24 week rib+peg treatment. I'm told a diagnosis of acute hep c is so rare that it's next to impossible to do a proper study so we're outta luck?

Response from Dr. Taylor

When we catch hepatitis C, we have a few months in which our immune system tries to fight off the infection. About 15-20% of people will win this battle, usually without knowing this, and clear away the hep C virus spontaneously, without any treatment. Then the hep C antibody test will remain reactive, showing prior exposure, but the HCV RNA, the blood test for the virus itself, will be negative, the the infection is gone.

Most people, 80-85%, will not clear away the virus in the first 6 months of infection, and will go on to develop chronic hepatitis C. This means that the virus keeps making copies of itself in our liver cells. At this point the infection cannot go away on its own, but it is curable with medicines.

SO it is beneficial to wait 12 weeks after being diagnosed with acute hep C, to see if you clear the infection away on your own. There is no need to take medications if you clear away the infection on your own in the first few weeks-months.

There are good data on treating acute hep C with interferon and ribavirin. However since the newer pills, called DAAs (direct acting antiviral agents), are less toxic and are more effective than interferon, many people choose to wait and take DAA pills alone without interferon. This is an option for you.

Your genotype, the strain of hep C you caught, is also important to consider. For example some experts would say that it is not worth it to take interferon/ribavirin for 6 months, when if you are genotype 2, you could take sofosbuvir plus ribavirin pills for chronic hep C, for 12 weeks, with an equally good chance of cure.

There are very smart scientists study the best treatments for acute hep C. For example Dr. Daniel Fierer studies this in NY, amongst HIV-infected gay men and other men who have sex with me. In addition, on a large scale, the ACTG, the largest clinical trials organization in the world, will soon be looking at DAAs for acute hep C, for people infected with HIV. If you live in the US and are living with HIV, ask your doctor about accessing this ACTG study.

It is important when we are diagnosed with acute hep C, to talk with our doctor about how we caught this infection, and to learn how not to pass it on to others. If we get treated and cured, remember that we can get infected again if we engage in the same behaviors that led to our first hep C infection.

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